Diabetes UK & Low Carb Diets – what is the official advice for diabetics?

The World Health Organisation (WHO) estimated that there were 171 million diabetes sufferers worldwide before the end of the last century. The (WHO) estimates that this will rise to 366 million by 2030. To use another data source to fill in some blanks and to get a longer timescale picture, another 2006 article estimates that the number of diabetics has risen from 30 million to 230 million in 20 years – that would be consistent with the WHO assessment.

Let us put three facts together – all UK data:

1) There were an estimated 400,000 diabetics in the UK in 1960, 800,000 in 1980, 1,400,000 in 1996 and 1,800,000 in 2004. If we assume that the increases followed a straight line, we can estimate that there were 600,000 diabetics in 1970 and 1,600,000 at the end of the last century – almost a three fold increase in the last three decades of the 20th century. www.diabetes.org.uk/Documents/Reports/in_the_UK_2004.doc

3) The National Food Survey for 1974-2000 confirms that we consumed 51.7 grams per person per day of saturated fat in 1975 and 28.1 grams in 1999. Consumption of the following real foods went down: meat; eggs; fats; butter; fresh potatoes; all vegetables; fresh green vegetables and whole milk. In some cases, the reduction in the consumption of real food was dramatic – we eat half the number of eggs that we used to and one fifth of the butter and whole milk. In contrast, consumption of the following foods has gone up: confectionery; fruit products (more than doubled); ice cream and ice cream products (nearly tripled); processed meat; processed milk; cereals and cereal products; processed vegetables; processed potatoes (oven chips etc) (nearly tripled) and soft drinks (consumption of soft drinks in the year 2000 was over five times the consumption in 1974).

So, in the final quarter of the 20th century (the period of our ‘new’ diet advice), the incidence of diabetes nearly tripled, obesity increased almost 10 fold and our consumption of saturated fat almost halved and our consumption of real food fell dramatically – largely replaced by processed food, especially carbohydrates. Do we need Miss Marple for this evidence?!

The very first sentence says that the low carb diet debate has been going on for two decades – and yet Diabetes UK still fails to show any inclination of doing what it should do – taking a stand against the one macro nutrient that diabetics cannot tolerate – carbohydrates. If the 20 year debate has had no impact on advice for type 2 diabetes thus far, how many more decades will it be before Diabetes UK does the right thing for people who can’t handle glucose?

There are a number of points that I would like to make about the Diabetes UK statement:

1) The Diabetes UK conclusion is flawed in numerous ways

The conclusion reached by Diabetes UK is presented after the opening paragraph:

“Diabetes UK has concluded that:

Evidence exists suggesting that low-carbohydrate diets can lead to improvements in HbA1c and reductions in body weight in the short term (less than one year).

Weight loss from a low-carbohydrate diet may be due to a reduced calorie intake and not specifically as a result of the carbohydrate reduction associated with this diet.

Despite the short-term benefit there is a lack of evidence related to long-term safety and benefit of following this diet.”

(The HbA1c test, by the way, gives an indication of blood glucose levels over the previous 2-3 months. It indicates the amount of glucose that is being carried by red blood cells in the body. It is a good indication, therefore, of the dangers faced by that person over time – a high HbA1c reading indicates high general levels of glucose in the blood. It is high blood glucose levels over time that lead to the many and varied complications of diabetes – nerve damage, eye damage, heart disease and kidney disease etc).

Here are some unique benefits that carb restricted diets have over calorie restricted diets:

a) Accumulation of adipose tissue (body fat) happens when triglyceride is formed. Triglyceride is formed when three fatty acids are joined by a ‘backbone’ of glycerol. The fats are ‘cycling’ in and out of fat cells all the time. They can only get locked into the fat cell, as a triglyceride, when glucose is present to enable the formation of the glycerol backbone. What provides glucose? Carbs. Hence we get fat (accumulate adipose tissue) by eating carbs.

Fat storage is also facilitated by insulin (the fattening hormone) and hence eating carbs also encourages insulin to be released (an impaired process for the ‘insulin resistant’ type 2 diabetic), which further aids fat storage.

b) People who believe that weight loss can only come about with a calorie deficit are making a number of incorrect assumptions about thermodynamics and the calorie theory. I dissect all of these in The Obesity Epidemic. To go into just one of the errors here, by wrongly interpreting the first law of thermodynamics and therefore wrongly ignoring the second law, it is concluded that “a calorie is a calorie”. Here is an extract from The Obesity Epidemic:

“As regards the second aspect of entropy in a human – energy used up in making useable energy – Eric Jequier, who works in the Institute of Physiology, University of Lausanne, Switzerland found that the thermic effect of nutrients (thermogenesis) is approximately 6-8% for carbohydrate, 2-3% for fat and 25-30% for protein.[i] I.e. approximately 6-8% of the calories consumed in the form of carbohydrate are used up in digesting the carbohydrate and turning it into fuel available to be used by the body. In contrast, 25-30% of the calories consumed in the form of protein are used up in digesting the protein and turning it into fuel available to be used by the body. This also makes intuitive sense; carbohydrates are relatively easy for the body to turn into energy (indeed they start being digested, and turned into glucose, with salivary enzymes, as soon as we start chewing). Protein needs to be broken down into amino acids, which is a far more complex process.

“Richard Feinman and Eugene Fine, a biochemist and a nuclear physicist respectively, have done some outstanding research in the area of thermodynamics and metabolic advantage of different diet compositions. In their 2004 paper,[ii] they took Jequier’s mid points (7% for carbohydrate, 2.5% for fat and 27.5% for protein) and applied these to a 2,000 calorie diet comprising 55:30:15 proportions of carbohydrate:fat:protein. This demonstrated that 2,000 calories yielded 1,848 calories available for energy. I repeated the calculation for a 10:30:60 high protein diet, as another example, and the yield drops to 1,641 calories.[iii]

“With this Jequier, Feinman and Fine research the first law of thermodynamics is satisfied – the books balance – we can account for all 2,000 calories in and out. And the second law holds – we have ‘useful’ energy (1,848 calories in Feinman and Fine’s example) and ‘useless’ energy (152 calories), the energy used in conversion. I don’t understand why this alone has not ended the debate and proven, once and for all, when it comes to eating and weight, a calorie is not a calorie.

“As Feinman and Fine so beautifully put it, if a calorie were a calorie, the second law of thermodynamics would be violated. That is to say – if all calories gave the same energy available to the body then there would be no difference in energy used up in making energy available and the law of entropy would be invalid in the human body. Pure carbohydrate calories are very different to pure protein calories once ingested.”

What this all means in lay terms is that protein can have a substantial ‘calorie advantage’ over carbs, simply because the body uses up far more calories in making protein available to the body as energy than it does in making carbs available as energy.

c) Fat/protein can be used for Basal Metabolic Rate (BMR) needs. Carbs can’t – they can only be used for energy. Hence we can virtually eat our BMR calories ‘for free’ – the body can use fat/protein/vitamins and minerals for everything from cell repair to building bone density to fighting infection. The body can only use carbs for energy. So we can eat 1,200 calories of carbs (thinking that we will lose weight) and, in fact, we will need to exercise to ‘burn up’ these calories. They are pretty useless to the body for any of its BMR needs. This is one of many reasons as to why calorie counters can apparently eat so little and still not lose weight and why the UK, as a whole, is overfed and undernourished – fat and sick.

Here is another extract from “The Obesity Epidemic”

“Let’s keep the numbers simple and assume that our average woman needs 2,000 calories per day and that 1,500 of these are for basal metabolic requirements. The energy in and out belief is that, if she consumes only 1,500 calories and then uses up 200 calories exercising, she will lose one fifth of a pound (700/3,500). This makes far too many assumptions, which are not legitimate to make.

“First it assumes that no compensation is made in the basal metabolic rate. Secondly it assumes that no adjustment is made to the 500 calories needed above BMR. It assumes that the calories consumed can be used for BMR needs – a huge and erroneous assumption if the woman is eating the per capita average for processed food. We cannot ‘ring fence’, ‘red circle’, ‘protect’ – whatever terminology is meaningful for you – calories in this way. We cannot force the body to do its basic maintenance – we can only create the right environment for the body to have no reason not to do this. Given that we cannot guarantee that the body can or will use 1,500 calories for basal metabolic needs, less energy in will lead the body to cut back on these activities. The body can save cell repair, building bone density and fighting infection for another day. Exercising serves to further reduce the planned maintenance list for the body that day. Both reduced energy in, and any attempts to increase energy out, can also reduce the normal energy requirement beyond BMR (the 500 calories in this case). As we see in Chapter Fourteen, those who exercise may be tired and therefore less likely to do, say, household activities, which they otherwise would have done. The ‘cash machine for fat’ view also assumes that the body is able to ‘un-store’ fat on demand and that the biochemical environment does not matter.

“Here’s a simple analogy – if we lose our job and less income is coming in to the household, we don’t automatically raid savings, we cut back on spending. If you go on a diet and less energy is coming in, the body doesn’t automatically raid fat reserves, it cuts back on the energy it expends. The body can turn off its heating system, for example, in the same easy way that we turn off the home heating system to try to save money. I use the expression eat less and/or do more as “The General Principle”, but, the advice is more typically to eat less and do more. The analogy works well – where is the sense in going out partying when you’ve lost your job. You don’t even feel like partying when you’ve lost your job and you don’t feel like going to the gym when you’ve had 1,000 calories of processed food. Think also of the damage done to the household if you try to do more with less coming in. We can see what happens to the human body when people try to eat less and do more. Just watch The Biggest Loser – the modern day equivalent of Gladiators.

d) Low carb diets are more satiating and can more easily be tolerated, as the person need not go hungry. The Minnesota Starvation experiment is the definitive case study of what happens when we try to inflict a calorie deficit upon human beings. The fact that the 36 conscientious objectors in this study could not tolerate hunger, even when held in captivity to ensure that they did not gain access to food, just shows how unbearable it would be for a ‘free range’ human to try to withstand hunger. Study after study, since Benedict 1917, has shown that hunger can only be tolerated for a very short period of time (weeks, not months) and that virtually everyone will overeat, to compensate for any calorie deficit, in the short to medium term.

Low carb diets need not restrict calories and low carb dieters, therefore, need not go hungry and need not feel compelled to overeat to ‘restore’ calorie intake. Low carb dieters are likely to miss carbs – some for longer than others – but overcoming the sense of ‘missing’ certain foods is far easier than overcoming life long hunger. There is indeed no evidence that the latter can be done. (Victoria Beckham, perhaps, being one exception)!

e) We have known since Benedict (1917), through Stunkard & McLaren-Hume (1959) to Franz et al (2007) – with many more in between – that calorie restriction does not lead to long term weight loss. Stunkard and McLaren-Hume quantified the ‘success rate’ of calorie deficit dieting as:

“Most obese persons will not stay in treatment for obesity.Of those who stay in treatment, most will not lose weight, andof those who do lose weight, most will regain it.”[iv] Stunkard and McLaren-Hume’s own statistical study showed that only 12% of obese patients lost 20 pounds, despite having stones to lose, only one person in 100 lost 40 pounds and, two years later, only 2% of patients had maintained a 20 pound weight loss. This is where the often quoted “98% of diets fail” derives from.”

Given the health benefits to any person, but diabetics especially, of losing weight and given that calorie deficit diets are well documented NOT to lead to sustained weight loss, surely Diabetes UK must be more open to alternatives (and I don’t mean bariatric surgery here – let’s try eating food – real food – first?!)

f) To an independent researcher there is clear evidence for the benefit of low carb diets over low calorie diets. However, you need to look at the data with an open mind – or you will conclude as the authors of “Popular Diets: A Scientific Review” concluded below:

Here is another extract from The Obesity Epidemic – Appendix 1 in my book has the full details of the 17 isolcaloric studies that were reviewed (Isocaloric = same calories/different composition of carbohydrate, fat and protein). So this means that a number of studies were done where people were given the same number of calories and the form in which those calories were eaten was the thing that differed. Some were high carb, some were low carb – the authors concluded that the only thing that mattered was the calorie level. This could not be further from the truth…

“Many studies, including and since Kekwick and Pawan’s 1956 paper, show that low carbohydrate diets are more effective than low calorie diets and isocaloric studies also show that low carbohydrate diets have a distinct advantage. As Feinman and Fine observe “These reports have not been refuted, but rather largely ignored.”[v]

“Marjorie R. Freedman, Janet King, and Eileen Kennedy wrote an article called “Popular Diets: A Scientific Review”, where 17 studies of weight loss with different macronutrient (carbohydrate, fat and protein) composition, are reported with the concomitant results.[vi] The authors state that “no published studies are excluded”, so I have assumed that these are the only studies between 1956 and 2001. The three authors concluded “Caloric balance (calories in vs. calories out), rather than macronutrient composition is the major determinant of weight loss.” Yet I analysed all the data for these 17 studies and found no relationship between low calorie intake and high weight loss (0.009 correlation coefficient), but a significant relationship between low carbohydrate intake and high weight loss (0.79 correlation coefficient) (Appendix 1). How can the authors have concluded as they did, unless they set out to prove an already held point of view?”

g) I have written a great deal about food addiction and common causes of food addiction (Why do you overeat? When all you want is to be slim (2004) and Stop Counting Calories & Start Losing Weight (2008)). I have yet to work with someone who craves salmon or steak or green vegetables. Dieters crave carbohydrates and particularly refined carbohydrates. In my personal experience, and from having worked with many overweight food addicts, it is vastly easier to avoid the foods to which one is addicted rather than to try to eat them in moderation. I have never understood how medical professionals will tell smokers to stop smoking and alcoholics to stop drinking and drug addicts to stop taking drugs and then tell food addicts to have their ‘fix in moderation. (The answer is that such medical professionals don’t believe in food addiction, which is somewhat ironic given that they do believe in fairy stories like 5-a-day).

The foods that are craved are not part of a real food/low carb diet and hence food addicts are not expected to be able to eat their drug in moderation. After a few days of (sometimes quite severe) withdrawal symptoms, people report having no further cravings for things that they would previously have stolen, if necessary.

As a final point in this section, on the efficacy of low carb vs low calorie diets, if you come across anyone who still has any doubt as to which will work best and/or any remaining view that the only thing that matters is calories – here is what this doubter needs to do (this would be a repeat of the famous Kekwick & Pawan experiment of 1956 for the modern day).

– For one week eat 3,000 calories a day of zero carbohydrate. The person can eat any naturally produced meat, fish and eggs and nothing else. (I will never encourage the consumption of any processed food – even zero carb processed meat for just a few days. Manufactured concoctions have no place in a healthy diet). They can cook with butter, lard and/or olive oil.

– For the next seven days, eat 3,000 calories a day of pure carbohydrate. The only food that is pure carbohydrate is sugar (sucrose/table sugar), but, if they can’t manage a 100% carb diet (which is the equal opposite to 0% carb) then at least consume foods as low in fat/protein and as high in carb as possible. There are plenty of options in supermarkets – Haribo and other sweets, sugary fizzy drinks, sugary low calorie cereals (try to pick a low protein one to be fair to the experiment), low fat/low calorie biscuits and other processed junk etc.

The skeptic needs to see how much they lose eating zero carb and see how much they gain eating nothing but carbs. You have every right to tell them: “Please don’t try to argue that a calorie is a calorie unless you have done this experiment.”

2) Our current diet advice has prevailed for the blink of an eye in evolution terms

The second point to be made about the Diabetes UK conclusion is a short one. Can you believe that third bullet? With reference to low carb diets: “There is a lack of evidence related to long term safety”. How about 3.5 million years?!

Here’s one of my favourite things to say in radio interviews:

“If we have been eating real food for 24 hours, agriculture gave us large scale access to carbohydrates four minutes ago and sugar consumption has increased twenty fold in the past five seconds. I wonder which food is more likely to be responsible for the obesity epidemic or any modern disease…”

In the UK, our current diet advice has been our current diet advice for fewer than 30 years. I am considered radical and yet what I advocate (eat what nature provides) was the conventional wisdom since time began until about 30 years ago. Our grandmothers still know that carbs make us fat. “Meat and two veg” was folklore for good reason – because that’s how we knew we should eat. It was only in 1983 that we decided that we had been wrong all along and we should be eating manufactured foods and not the natural fats and protein provided in abundance by nature:

“The previous nutritional advice in the UK to limit the intake of all carbohydrates as a means of weight control now runs counter to current thinking and contrary to the present proposals for a nutrition education policy for the population as a whole… The problem then becomes one of achieving both a reduction in fat intake to 30% of total energy and a fall in saturated fatty acid intake to 10%.”

Proposals for nutritional guidelines for Health Education in Britain (1983)

And so started the obesity epidemic…

Dare I suggest that there is no money to be made in natural food provided by Mother Nature? Value added is the domain of Ronald McDonald and food manufacturers.

3) If you want to maximise nutrition, you must minimise carbs

The nutritional errors in the Diabetes UK statement are just staggering. I often wonder why more dieticians don’t spot the conflict (maybe they do and they have a means of ignoring it). When you study where vitamins and minerals are found in food it is an inescapable fact that the only complete proteins (all amino acids provided) come from animal foods and the highest (sometimes only) source of vitamins and minerals is animal foods – meat, fish, eggs, dairy. For the Diabetes UK statement to make the point that nutrition is key (“Nutritional adequacy should be considered ensuring that optimal amounts of vitamins, minerals and fibre are supplied by the diet”) and then to promote carbs above fat and protein is just nonsensical.

Let’s just take some vitamins and minerals as examples (all of the analysis that follows is done by weight – comparing 100g of each product)…

Vitamin A: Liver has over 200 times the vitamin A in an apple and only animal foods contain retinol – which is the form in which the body needs vitamin A. Vegetable fans will promote the vitamin A content of spinach. However they won’t tell you the following about vitamin A:

a) Only animal products contain retinol;

b) Plant sources of vitamin A come in the form of carotene, which requires conversion within the body into retinol;

c) Even with Beta-carotene, the carotene most easily converted into retinol, there is substantial loss such that the conversion ratio is at best 6:1 (“The accepted 6:1 equivalency of beta-carotene to preformed vitamin A must be challenged and re-examined in the context of dietary plants”);[vii]

d) Not every person is capable of converting carotene to retinol “Diabetics and those with poor thyroid function cannot make the conversion. Children make the conversion very poorly and infants not at all”[viii] and

e) Carotenes are converted by the action of bile salts and very little bile reaches the intestine when a meal is low in fat. Our grandparents put butter on their vegetables for good reason. We can confidently assert, therefore, that animal food generally, and liver particularly, are the best sources of vitamin A.

Vitamin B group: There are 8 B vitamins and liver is the best source (by weight) for B2 (Riboflavin), B3 (Niacin), B5 (Pantothenic Acid), Folic Acid and B12. Liver has 18 times as much B2 and 30 times as much folic acid as brown rice. Liver has over 30 times as much B5 as kidney beans and 16 times as much B3 as kidney beans. There is, of course, no plant source of B12 – this has to come from animal foods (or manufactured supplements/injections).

Calcium: Sardines are one of the best sources of calcium – over 25 times the amount found in flour – the single food that the average Brit and American eats the most of – over 700 calories of the stuff each day.

Iron: Liver (again!) has over 3 times the iron of spinach. Cocoa powder has even more than liver – and cocoa powder also comes with an excellent serving of saturated fat. The iron levels in fruit, flour and grains are not worth mentioning. Lentils provide a decent amount, but you would have to eat 850 calories worth of lentils every day to get your minimal recommended daily iron requirement. (Compare this with 225 calories of liver to get the recommended 18mg of iron daily).

The two foods that we currently eat the most of in the UK are flour and sugar. We eat virtually 1,150 (empty) calories of these two ingredients alone. Flour has so little nutrition that it is usually fortified (nutrients added in the manufacturing process); sugar (sucrose) has none. How can Diabetes UK be content that we stick with the current low fat/high carb diet?

Even ignoring for now the horrific impact that the macro nutrient (macro nutrients are carbs, fats and protein) advice is having on diabetics (the advice to eat carbs and not fat/protein having a serious and life harming effect on humans), the micro nutrient (vitamin and mineral) advice just doesn’t add up. Diabetes UK want us to have “…optimal amounts of vitamins, minerals and fibre” and yet they are not promoting the food with the optimal amounts of vitamins and minerals. (Don’t even get me started on fibre – it is just an excuse to promote carbohydrates – it can actually cause a loss of vitamins and minerals if it unnaturally speeds up our digestion process – rushes food into the toilet before we have absorbed all the vitamins and minerals.)

Diabetes UK – if you really want to optimise nutrition – you have to promote a diet of meat, fish, eggs, dairy (all naturally reared of course), vegetables & salads and nuts & seeds and that’s about it. Oh, and by the way, this will massively help the insulin burden and physical damage currently being placed on the diabetics that you are supposed to represent.

4) Diabetes UK don’t seem to want diabetics to lose weight!

I have to quote this bit directly: “If carbohydrate intake is severely restricted and glucose stores are exhausted, the fat stores will be broken down and used as energy.” Isn’t that precisely what overweight and obese diabetics need and want to happen?!

Obesity is a significant problem in diabetes – diabetics are more likely to be overweight/obese than a non diabetic person and overweight and obese people are more likely to be diabetics:

“The JAMA (1999) article “The Disease Burden Associated with Obesity and Overweight” estimated that a male under 55 and with a BMI of over 40 has 90 times the chance of developing type 2 diabetes than a normal weight male of the same age.[ix] Although this study found the risk for women slightly lower, other studies have corroborated this multiple for women. Colditz et al (1995) found that women with a BMI of more than 35 had 93 times the risk of developing type 2 diabetes than women whose BMI was less than 22.[x] A BMI of 35 is also not breathtakingly high – 1.2 million people in the UK currently have a BMI of over 40. An average height woman (5’4”) who is 14 stone seven pounds has a BMI of 35 and an average man (5’9”) who weighs 17 stone has a BMI of 35.” (p35 The Obesity Epidemic)

We need to take care making allegations of causation – obesity may cause diabetes; diabetes may cause obesity; both may be caused by eating excessive amounts of carbohydrate – there are many scenarios (I believe all three of these).

So, Diabetes UK admit that fat will be broken down in the absence of glucose (fat will, in fact, only be broken down in the absence of glucose – if any glucose/glycogen is available, the body will use this for energy rather than burn body fat). We know that obesity is a significant complication for diabetes and probably a cause and yet Diabetes UK don’t want to offer support for something that would cause weight loss – the break down of fat stores in the absence of glucose (i.e. carbs). I find this quite literally inexplicable and unforgiveable.

Perhaps the next point can explain how this could possibly happen…

5) Diabetes UK is a conflicted organisation – its advice can, therefore, not be trusted

Check out Canderel, Cambridge Diet, DietFreedom, Jelly Belly (what ?!), Kellogg’s, MullerLight, Shredded wheat, Splenda and The Co-op – plus, of course, the full range of pharmaceutical companies. None of these sponsors would benefit from diabetics eating real food, losing weight naturally and needing less medication. Even the banks on the list would benefit from diabetics staying fat & sick, dying early and not putting a strain on pension funds.

Could this be the reason that Diabetes UK will not support real food/low carb dietary advice? Would they really rather support bariatric surgery, before recommending the absence of glucose, which they know will cause a break down in body fat i.e. weight loss?

I have stopped supporting a number of charities – The British Heart Foundation (for their statin/cholesterol misinformation); The World Cancer Research Fund (because they keep attacking me for telling the truth about 5-a-day, while they promote Fruity Friday with DOLE as one of their sponsors); Marie Curie cancer care (because they are selling sweets at the point of sale in post offices and small shops UK wide – Dr Otto Warburg: “But, even for cancer, there is only one prime cause. The prime cause of cancer is the replacement of the respiration of oxygen (oxidation of sugar) in normal body cells by fermentation of sugar.”[xi]) and so on. You may like to think about potential misinformation and conflict that you might inadvertently support by signing a sponsor form or sticking some money in a collection box.

Post Script

To end this blog – here’s a quote posted on our wall on Facebook (15 April 2011):

“Hi Zoe, I have something fantastic to tell you….

A gave a copy of your book to friends of ours, John & Ineke, on our last trip to New Zealand in Feb/March. Ineke, like me, only needed to loose a few kilos and I knew that by letting her in on this ‘ fab way of life’ she would love me forever ;- Well, Ineke has lost 7 kgs in 5 weeks and man does she love me !!!!

Now to John ( this is the best bit ). John has suffered with diabetes for over 12 years, having to inject insulin twice a day and also take tablets….. (he’s also over weight). To be honest, I had no idea what insulin was good or bad for before reading your book….. then I started thinking……. If John was to follow THD [The Harcombe Diet] he could totally get the diabetes under control and probably wouldn’t have to inject insulin or take tablets! ?????????

John told me that together with his GP they had tried all diets under the sun and it didn’t work but, he promised Ineke and I that he would give it a go. John start THD and after only 2 days he didn’t need to inject insulin and after 4 days no tablets were needed !!!!!!! He is so happy Zoe.

He went to see his GP last week who almost fell off his chair :-)))) The GP has already ordered your book hahahaha.

[ii] Richard Feinman and Eugene Fine, “A calorie is a calorie violates the second law of thermodynamics”, Nutritional Journal, (2004).

[iii] I first repeated the Feinman and Fine (F&F) experiment and my calculation for a 55:30:15 carbohydrate:fat:protein diet gave a yield of 1,825 calories, not the 1,848 recorded by F&F. I contacted Dr. Feinman who confirmed that there had been an arithmetical error in their calculations, but the difference is small and would have only served to make their point more profound.

[iv] Stunkard A. and M. McLaren-Hume, “The results of treatment for obesity: a review of the literature and report of a series”, Archives of Internal Medicine, (1959).

22 thoughts on “Diabetes UK & Low Carb Diets – what is the official advice for diabetics?”

Hi, great article, I’ve been classed as Pre-diabetic, my Mum and Nan had Diabetes, so Doc thinks I’ll get it. I’m male, 52, 5’9″, 130lbs, lost a fair bit of weight recently, though I run around 30 miles a week.
My question is what is your response to the WFPB low fat recommendations out there, i.e. The Starch solution, they recommend a 80/10/10 ratio of Carbs/Prot/Fat?
They, and a lot of other sites, suggest fat in the cells is what makes one Insulin resistant, and we should lower fat, raise carbs in our diet. This will supposedly lower the fat content in the cells, and allow one to become Insulin sensitive, and allow for the sugar to get into the cells, rather than staying in the blood due to not being able to enter the cells.
I’m really keen to adopt a diet for life, I’m currently on the 80/10/10 diet, feel ok, apart from the weight loss and muscle wastage(Though as I said, that could be from the running), and the rising Blood glucose numbers.
I’ve done LCHF before, and my Cholesterol skyrocketed to over 10, with my LDL being high, and primarily the small, dense, supposedly bad LDL.
I started to add starches, lowered fat, and my cholesterol lowered to a better number, according to Doc!
There is so much conflicting info out there. I just listened to the Chris Kresser/Joel Kahn interview, nd they agree on plants, fruits, whole foods, but as for fats in diet, the polar opposite!
Many thanks for reading.
Dave

Hi Dave
There are more than two choices and those are pretty extreme (in my view). 80/10/10 carb/prot/fat is as extreme as 80/10/10 fat/carb/protein.

My philosophy is “eat real food and then choose that food for the nutrients it provides.” That will naturally drive one more towards meat, fish, eggs, dairy, green things, etc, but you don’t have to get hung up on macros.

when you have no medical training or professional background , you tend to believe everything told to you by your diabetic nurse (yes she is diabetic too) and follow diet suggestions. Yet when I read your article, it made such sense and so simply written for the lay person to understand. Thank you , thank you. I am a type 2 diabetic at the moment but no longer intend to remain so.

There is SO much out on the net about type 2 diabetes and diet. Professor Tim Noakes, Prof Stephen Phinney, Dr Malcolm Kendrick, Dr Jason Fung (the man in the video) – they are all worth following and then you’ll see many people saying the same thing – diabetics can’t handle carbs so how can we advise diabetics to base their meals on carb?!

I have been low carb for over 3 years, stopped metformin after just 3 months in. My sugar levels have been normal all this time! I, too, have stopped donating to certain charities because of their ties to big pharmacy or big food companies!

Hi Kate
That’s uncanny – my hubby has just spotted today’s World Diabetes Day is backed by the who’s who of the pharma industry!
I also now donate to local (small) animal charities – very little national and nothing medical :-)
Best wishes – Zoe

This is an old post (been reading my way through your blog), but I had to share. Reading this reminded me of when I was pregnant with my first child and was diagnosed with gestational diabetes. Of course I had to do the inevitable dietitian visit where I was told what to eat. Now I was already a carb junkie (still am, sadly – I’m trying to cut down!), but the amounts of carbs this woman wanted me to eat with every meal had me staggered, and she seemed annoyed with me when I told her I simply couldn’t eat that many carbs. This was over 10 years ago, but I imagine it’s not that different now. I’m a smart person with a medical background, so I’d like to think I do understand how diabetes works, but for a while there I got confused, and I think I ate way too many carbs as a result because that’s the message I got – not eat fewer carbs, but eat more carbs! As a result I probably spent far too much time worrying about my blood sugars, which were always fine. (By the way, my baby was born macrosomic, but with no other health issues – currently a lean teenager. With my second child I had no GD diagnosis, probably ate fewer carbs although I did eat like a horse, and had a baby almost exactly the same weight as my first.) Also, I was given morning tea at the hospital once when I had to attend a diabetes clinic that went on for far too many hours. It was biscuits and orange juice, and then they freaked out when I had a high blood sugar reading shortly afterwards. The mind boggles.

Hi Julia – many thanks for sharing this. A friend’s dad was diagnosed with t2d later on in life (70s) and he was given the same advice. He had always been a meat and 2 veg man – just toffees and a pudding every now and again as he had a bit of a sweet tooth. He sadly would not listen to his daughter (respect for people in position no matter what). He listened to the dietician instead and his weight has gone up as fast as his energy has gone down. His blood glucose is virtually uncontrollable with the carbs he is eating!
We need the first law suit and then the flood gates will open
Best wishes – Zoe

Great article Zoe. Shocking to note that Diabetes UK is sponsored by the very organisations (drugs companies) that make the drugs to supposedly cure (but in reality just treat) diabetes. The very companies that would lose millions if we did actually cure diabetes….by eating less carbs…..it also looks like Diabetes UK have removed some of the sponsor information about food manufactures you detail above now….I wonder why?….

Great article, I am training to be a Dietitian (first year of post graduate)and the Diabetes UK guidelines are contradictory and are extremely easy to critique(in my a opinion are terrible). Agree with everything in this post

I just finished watching your hour long video on The Obesity Epidemic, reviewed your slides, ordered your book, and am reading your blog. I’d like to thank you: You have an amazing knack for distilling all the conflicting advice into clear, understandable and science-based recommendations. In this post alone you manage to cover a tremendous breadth of subjects (without sacrificing depth while you do it). How refreshing.

Your section on carb restriction really hit home for me. I was one of those facing bariatric surgery as the solution to a problem that my doctors and nutritionists were never quite able to explain. Fortunately, I found a low carbohydrate way of eating before I went through with the surgery, and managed to drop 120lbs in about a year (still have a long way to go). I’m glad your advice is out there, helping others in the same boat, and introducing critical thinking into a domain long predisposed to dogmatic repetition of what essentially amount to meaningless platitudes and nostrums. The very fact that you would write (in bold no less) something like, “If you want to maximise nutrition, you must minimise carbs” brings a smile to my face as surely as it must drive the mongers of conventional nutritional wisdom crazy. Keep it up, and you just might change the world…for the better.

Hi Zoe,
Firstly, I think your blog’s brilliant. I’m a 3rd year dietetic student really struggling with the fact that I will be expected to be follow the current dietary guidelines when I qualify, including the Diabetes UK recommendations. I hope you keep trying the reverse the obesity epidemic and writing interesting articles (although, I’m not going to get my hopes up that many people will properly listen to them as we have systematically brainwashed ourselves into thinking body fat could only have originated from dietary fat)…
Anyway, I just have one small point about basal metabolic rate. You mention above that we can’t use carbohydrates for our BMR, but only fat and protein. I think instead the energy for BMR is mostly from fat (70%) and the remaining 30% is from carbohydrates. I don’t think protein would be used really except in extreme cases, such as starvation or illness. A few books I’ve read seem to indicate that’s the case anyway. The 2nd chapter in Essentials of Strength Training and Conditioning (by Joel Cramer, 2008) covers it, too.
:)

With all due respect, I don’t seem to get the point of b) (thermogenic properties of various calories).

The calories-in calories-out calculation is flawed because
A. Calories-in is not constant – apart from different gut flora, digestion pecularities etc., people do not keep their calories constant, they eat until satiated (which depends on protein and other nutritients) or will risk serious damage. This is the established mechanism of LC “diets” – no hunger.
B. Calories-out is not constant – apart from losing calories in shoddy digestion, nitrogen and ketones through fluids, metabolism depends on hormones and calories-in, entering starvation mode when not enough comes in through A.

Now you seem to make the point in b) that protein calories use up more energy in digestion. I fail to see how this should be relevant, at least how it should be relevant compared to the huge effects of A. and B., since

a) If you are actually burning precious protein-in for energy, you are probably doing it wrong. Protein is for muscle growth and tissue repair.
b) Any energy that is “lost” in metabolism (unless excreted) simply ends up in body heat. Now it happens that a significant share of our calories is used for thermoregulation anyway (unless you are doing really hard physical work at about 20 MJ/d and more). These “losses” are not really helping, I should think.

My husband is a type 1 diabetic using insulin. Unlike the vast majority of diabetics he need to put weight on rather than lose it! However he does need to get his diabetes under control as his blood sugars can be all over the place!
Any suggestions?

I got on the scales in March and they screamed at me to get off! I looked for a diet that I could follow for the rest of my life and not just until I’d lost a bit of weight. I hit on low carbohydrate/ paleo/primal whatever you want to call it and decided if I could eat meat and just cut out grains, I would probably be OK. I really miss Marmite on toast but compensate with fish and eggs. I’m losing about a pound per week as I still drink wine and indulge in other naughtiness.

The week before last I decided to have a look at counting calories as an additional strategy. I found that I could halve my breakfast calorie intake without feeling hungry. Win-win. With a bit more exercise I believe I may be able to get up to losing 2lbs per week, again, without feeling hungry. I am also finding that food does not repeat on me now, which it did when I had french stick or toast.

I could never understand why diabetes – a disease of carbohydrate intolerance – was not treated by eating less carbohydrate.

Then I realised that less carbohydrates means more fat, as our ability to utilise protein is limited, and that the establishment is now so lipophobic that they cannot bring themselves to recommend low carb eating for the simple reason that it is high fat eating.

I always have a question about the phrase “naturally produced meat.” For example, if we are talking about beef I always interpret it to mean grass-fed without all these chemicals that factory farms use to keep the cows large and healthy on a poor diet. This is often hard to find and when found it is expensive. If I go to a general grocery store and buy a steak, do you count this as “naturally produced” and think the nutritional value is worth the trade-off of unknowns surrounding mass produced meat?

This is a conundrum I’ve had for a long time. I tend to eat a whole food, plant based diet that has essentially no high glycemic index carbs. I eat meat when I get around to a farmers market, but wish I could do more. Thanks!

Zoe if you look around Blogland you will see pretty much universally the Lo Carbers are considered Fanatics, throw in the word ATKINS and you are instantly dismissed as a joke.
The way the case is presented needs to go something of a rethink. A concentration more on the success than the conventional ” bash carbs ” approach. IE what you can prove as opposed to what is claimed.

You mentioned the DUK citing that there is no long term evidence of Lo Carb being workable, well it used to be the prescribed diet before insulin became available didnt it.

You are so right to cite their list of Sponsors as Conflicts of Interest.
For the record i am a T2 who follows a lo Carb regime and I dont regret it for a second, My medical records back to 2007 show an improvement it weight and Hba1c etc etc. From my original diagnosis in 2000 up to 2007 showed increased weight and meds looking at Insulin therapy in 2007 also a matter of record. But sadly they dont record the diet aspect so any success will be attributed to the meds or calorie /portion control, which i assure you i dont.